Washington · nursing homes
Washington nursing home staff requirements: what you have to hold on every person
A Washington nursing home has to hold thirty-two dated things on file for the people it employs. Twenty-eight of them are federal and are the same in every state. Four are Washington's own, which is the busiest state layer on this site, and three of the four come back around rather than being done once.
What Washington adds
Four things, on top of everything every nursing home in the country already holds. Each one names the section of Washington law it comes from, so you can read it yourself rather than take our word for it.
| What we track | How often | Where the rule comes from |
|---|---|---|
| A TB test when they start, and again every yearThree days is the tightest health deadline on this site, and there is no waiver path. Washington is one of only four states that kept a yearly test rather than a yearly set of questions. | Within three days of their first shift, then every year | WAC 388-97-1380 |
| A background check for anybody with unsupervised access to residentsUnsupervised access is the test, not payroll, so contractors and volunteers are inside this. | Every 2 years | WAC 388-97-1800 |
| A food worker card for kitchen staffDue within 14 days of starting. The two-then-three pattern means the second date is not two years after the first, which is the sort of detail a spreadsheet formula gets wrong. | The first card lasts 2 years. A renewal lasts 3. | WAC 246-217 |
| Continuing education for the administratorOne person, one date, and the one item on this page whose absence is a problem for the building rather than for a shift. | 36 hours every 2 years, including 2 hours on health equity | WAC 246-843-130 |
Three days, and no way round it
The Washington TB deadline is three days from somebody's first shift, and that is short enough to change how hiring works rather than how tracking works.
A person accepted on Thursday and starting on Monday has until roughly Wednesday. If the test is a skin test, it needs placing and reading, which is two visits inside that window. If your occupational health provider has a four-day wait for an appointment, the deadline is already gone before anyone books it.
The buildings that hold this comfortably are the ones that book the appointment at the offer stage rather than at the start date. That is a hiring change, not a compliance change, and it is the only reliable answer.
The two-then-three card
The food worker card is the smallest item on this page and it causes a specific, repeatable error.
A first card lasts two years. A renewal lasts three. Anything that adds a fixed two years to every card will put every second renewal a year early, which means chasing people who are not due and looking careless in front of the people you are asking. Anything that adds a fixed three will do the opposite and let the first card lapse.
It is one line of arithmetic and it has to be right per card, not per person.
What every nursing home in the country holds
These twenty-eight are the same in Washington as they are everywhere else, and they are most of the job. Each one names a CMS tag, a piece of the federal code, or both. The guides go through the ones that get cited most.
Licences and certificates
| What we track | How often | Where the rule comes from |
|---|---|---|
| A current RN license | When it runs out. Most last 2 years. | F839 · 42 CFR 483.70(e) |
| A current LPN license | When it runs out. Most last 2 years. | F839 · 42 CFR 483.70(e) |
| Nurse aide certification, still active on the state list | When it runs out. Most last a year. | F728 · 42 CFR 483.35(d) |
| A current license for therapy, social work and pharmacy staff | When it runs out. Most last 2 years. | F839 · 42 CFR 483.70(e) |
| A current administrator license | When it runs out. Most last a year. | F836 · 42 CFR 483.70(a) |
| Proof the food service director is qualified, where no dietitian works full time | When it runs out. Most last 3 years. | F801 · 42 CFR 483.60(a)(2) |
| Proof the activities lead is qualified | When it runs out. Most last 2 years. | F680 · 42 CFR 483.24(c)(2) |
Checks you run on a person
| What we track | How often | Where the rule comes from |
|---|---|---|
| A look at the state nurse aide list before the first shift | Before their first shift, then every 2 years | F729 · 42 CFR 483.35(d)(4) |
| A check for any finding of abuse or neglect against them | Every year | F606 · 42 CFR 483.12(a)(3) |
Health and safety
| What we track | How often | Where the rule comes from |
|---|---|---|
| A first TB check: history, symptoms and a test | Once, in their first two weeks | CDC 2019 via 42 CFR 483.80(a)(2) |
| The hepatitis B shot offered free, and their answer written down | Once, within ten working days of starting | 29 CFR 1910.1030(f) |
| A mask fit test for anyone who wears an N95 | When it runs out. Most last a year. | 29 CFR 1910.134(f) |
| A current CPR card at the healthcare level | When it runs out. Most last 2 years. | F678 · 42 CFR 483.24(a)(3) |
Teaching and in-service
| What we track | How often | Where the rule comes from |
|---|---|---|
| Orientation, before they work on their own | Once, in their first week | F940 · 42 CFR 483.95 |
| Teaching on abuse, neglect and dementia care | Every year | F943 · 42 CFR 483.95(c) |
| Teaching on residents' rights | Every year | F942 · 42 CFR 483.95(b) |
| Teaching on stopping infection spreading | Every year | F945 · 42 CFR 483.95(e) |
| Teaching on the quality program | Every year | F944 · 42 CFR 483.95(d) |
| Teaching on the compliance and ethics program, if your company runs five or more buildings | Every year | F946 · 42 CFR 483.95(f) |
| Teaching on mental health and behavior needs | Every year | F949 · 42 CFR 483.95(i) |
| Teaching on talking with residents, for hands-on staff | Every year | F941 · 42 CFR 483.95(a) |
| Teaching on what to do in an emergency | Every year | 42 CFR 483.73(d)(1) |
| Teaching on blood and needle safety | Every year | 29 CFR 1910.1030(g) |
| Teaching on the chemicals they handle | When they start, and again when a new chemical arrives | 29 CFR 1910.1200(h) |
| Twelve hours of teaching for each nurse aide | 12 hours every year, counted from their own start date | F947 · 42 CFR 483.95(g) |
| A written look at how each nurse aide is doing | Every year | F730 · 42 CFR 483.35(d)(7) |
| Teaching on keeping resident information private | When they start, and again whenever your privacy policy changes | 45 CFR 164.530(b)(1) |
Employment paperwork
| What we track | How often | Where the rule comes from |
|---|---|---|
| Form I-9, filled in and kept | Once, in their first three days of work | 8 CFR 274a.2(b)(1)(ii) |
Three more that nearly every building does anyway
These three are not on the tables above, and the reason is narrow: they rest on federal guidance or on a reporting program rather than on a rule with a section number. Almost every nursing home does all three, several state Medicaid programs have made the first one a condition of payment, and a page that called them law would be a page a surveyor would stop trusting.
- A check against the federal list of people barred from Medicare and Medicaid work. Every month. A name that was clear in January can be on it in February, so this is one to run on employees and contractors alike.
- Teaching on the signs of TB. Every year. What the signs are, who is at risk, and what to do about it. Teaching, not a test.
- A flu shot, or their reason for saying no. Every year. Their answer either way, written down. The count of who said yes is what goes in the yearly report.
What you still have to check yourself
Real in Washington, and not on the tables above, because we could not put a section number next to it without guessing. Guessing at a citation is worse than admitting the gap, because the guess is the thing somebody quotes back.
- Nurse aide registration with the Department of Health within three days of somebody starting. Every Washington building does this. We could not pin the three-day window to a section number, so it is not in the table above.
Where the Washington rows came from
Read on .
Questions Washington buildings ask
How quickly does a Washington nursing home have to run a TB test?
Within three days of the person's first shift, under WAC 388-97-1380, and again every year after. Three days is the tightest health deadline of any state on this site, and there is no waiver path, so the test has to be booked before the person starts rather than after.
Does Washington require annual TB testing?
Yes. Washington is one of only four states that kept a yearly test rather than moving to the national 2019 approach of one test and yearly questions. If you have worked in a state that follows the national guidance, this is the biggest single difference in how much TB work a Washington building carries.
How often does Washington re-run a background check?
Every two years, for anybody with unsupervised access to residents. That reaches contractors and volunteers as well as employees, because the test is access rather than payroll.
Why does a food worker card last two years and then three?
Because the first card and a renewal have different terms. It is a small thing that causes a specific mistake: a spreadsheet that adds two years to every card puts the second renewal a year early, and a building that trusts the spreadsheet chases people who are not due.
Does Washington add nurse aide training hours?
No. Aide hours stay at the federal twelve a year, counted from each person's own hire anniversary. The 36 hours in the table above are the administrator's own continuing education and apply to one person in the building.
Where to go next
- How Credolex works in a nursing home
- F730: annual in-service hours, the guide behind the tag Washington leans on
- What Oregon asks for
- What California asks for
- What Illinois asks for
- Every state we have read so far